Treatment: PT using MedX per Mooney & later, McIntire research

[Kevin_Mc]

I've read the abstract of your pilot study and the later study. Haven't seen the full 'protocol' indicating specifics, such as the "burn out phase at the end". Is this available on the net?

I'll send you a copy.

As mentioned, I haven't read the "burst" details. Re. Type 1 deficit: e.g., when doing weights, I used to work up and down (from 100 lbs to 305lbs, then back to 100 lbs, up to 100 reps. 20 lbs increments, decreasing reps on the way up and vice versa. Strength. Later, mixed workouts and did sets of 50 - 100 lbs till bored. Endurance. My other daughter'll do 10 - 11 miles long run 1 x wk, low end aerobic stimulus chilling at 7:45 /mile, steady, low heart rate. When I say "endurance" as opposed to strength, I was suggesting that type of emphasis. Upping the cadence (running) or tempo (weights) would work speed and probably strength endurance as distinct from lower end endurance in both examples. Regarding scoliosis, to induce Type 1 use, the subject would exercise (with any appropriate paraspinal working exercise) for...for...quite a while and often (perhaps daily--for pure strength increases, heavier exercise on the same muscle group every 3 days or so)?

I think I understand your question/point. I could see how that would be a good strategy. But you have to make an exercise protocol palatable to the masses, unless you can show that inclusion of a specific 'item' is crucial to the success.

If I remember correctly, when asking you similar questions before, you replied that, after the strength had been equalised on both sides (i.e., asymmetric), you commenced symmetric exercise. Muscles work on both sides when rotating in either direction therefore "scatter-gun" the lot of them. Were you able to measure EMG activity to assess development of Type 1 on the concavity or did you use equalising strength as a proxy? Presuming that all sessions were sub-max, especially during the "burst", an equal 'effort' could have succeeded as masquerading for endurance equalisation?

The asymmetric part was only in terms of the weight. They still exercised in both directions. It was just that once the 'strength' appeared equal we increased the weight. I would still consider the exercises we had the patients perform to be symmetrical.

As far as EMG is concerned, surface EMG does not have the ability to distinguish fiber type. People try all the time to come up with algorithms and rationale for interpreting their EMG data to be a certain fiber type. But it's just not possible. I would liken it to those crime scene shows or movies that "zoom and enhance" a picture. We did, however, measure EMG. I just was not able to analyze it. Lots of logistical and equipment problems with the data collection.

In my dark mental state, I'd agree. (Just thinking aloud here.) Even at your "5% paraspinal use", TR, in addition to increasing ROM, could provide enough stimulation to induce auto-correction. Because of the main muscles used, TR has more benefit for lumbar or lower curves than thoracic curves. My opinion is that even when the lower curve is compensatory, stability and/or correction there can increase the progression threshold for a higher structural curve. AMon's suggestion to vary the CTR hand and arm position is intriguing, but who would do the study? Can you kick some good grad. students onto the job?

Unfortunately I have no grad students or money for that matter. I'm currently trying to land my next grant and/or find my next position. My days as a postdoc are effectively over and I'm trying to spread my 'wings'. Otherwise, as of July 1, you can probably find me at the local Starbucks. I'll be your barrista.

Agree again (my daughter does Schroth daily). Hitting the higher curves with Schroth too is more 'esoteric' than with lower curves--RAB, some wall-bar (body weight and band exercises) and some lying-on-the-side exercises with supports work well.

I think it's probable that a one-size-fits-all exercise protocol would have clear limits. Scoliosis is far too specific for that. If we want to target the muscles, we have to make sure we're aiming correctly. Although I think strength is extremely important, specificity is too.

[TAMZTOM]

From our study:

...may help explain the paradox of shorter multifidus on the convex than the concave side.

Wasn't aware that this was considered a paradox. My understanding, from Schroth, was that in, for example, a right thoracic curved patient, the left multifidus is overworked by holding the weight of the convex right side; the upper right quadrant muscles are overstretched; both lower left and upper right quadrants are vulnerable to atrophy after being overstretched/overworked. While this counter-balancing operates, the upper left and lower right quadrants (as you suggested) are underused, shorten and are also (but less so) vulnerable to atrophy, but, first, simply not used.

From other reading, the right side muscles are underdeveloped. TR can assist here as one exercise or activity specifically targeting that weakness (as you said). Also, the TL fascia, distorted by compensating pelvis and opposite thorax rotation, can't function as intended (used to apply and focus strength). Despite the observation that TR doesn't work as effectively on HT curves, I believe it can indirectly affect those HT curves by strengthening the lumbar; IMO, a compensatory lower curve is itself a contributory mechanism in the progression of structural curves--vicious cycle.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1079862/
Good article.

Sharon
Your "let them sleep...lots" idea gets aired in this very long article. :-)
(PS: despite the length, I think this article should be read by every parent of a kid with scoliosis)
http://www.scoliosisjournal.com/content/3/1/8#B96

[TAMZTOM]

But you have to make an exercise protocol palatable to the masses, unless you can show that inclusion of a specific 'item' is crucial to the success.

Yes, unfortunately that is the case for an exercise averse public. It's always going to be the case that only a few will do enough and be specific enough to succeed. (That's why I mentioned--somewhere on here--that I'm always focused on the few who did correct--i.e., my daughter would exercise all day if we didn't chain her up sometimes.) Study group for your next project on PT should select only Jocks.

As far as EMG is concerned, surface EMG does not have the ability to distinguish fiber type.

I think the above linked article I just posted tries hard on the EMG front, but only succeeds in confirming your statement.

Otherwise, as of July 1, you can probably find me at the local Starbucks. I'll be your barrista.

I have to admit that when I studied over in the USA, I haunted IHOP every morning for breakfast. Loved the weak American coffee...and was hooked on the "Rooty-tooty-fresh-and-fruity" with wholemeal pancakes to pretend that it was healthy.

Although I think strength is extremely important, specificity is too.

Finding those few effective exercises to slot into the daily routine would be wonderful. ASC is crucial, side-shift great if done as part of the ASC, RAB totally crucial...all ingrained into the vacated, formerly scoliotic, subconscious. The medical equivalent of a RTFAF.

[Pooka1]

[snip]...and was hooked on the "rooty-tooty-fresh-and-fruity" with wholemeal pancakes to pretend that it was healthy.

lol!
.
.





.

[Kevin_Mc]

Would you think of me less if I said that I'm not sure what our/my point was with that sentence. I can remember thinking it and even writing it, but can't fully remember what 'paradox' I was thinking about. I even went back to my dissertation to see if I used the same line or explained it better. No such luck.

Regardless...

Wasn't aware that this was considered a paradox. My understanding, from Schroth, was that in, for example, a right thoracic curved patient, the left multifidus is overworked by holding the weight of the convex right side; the upper right quadrant muscles are overstretched; both lower left and upper right quadrants are vulnerable to atrophy after being overstretched/overworked. While this counter-balancing operates, the upper left and lower right quadrants (as you suggested) are underused, shorten and are also (but less so) vulnerable to atrophy, but, first, simply not used.

I'm not sure what Schroth thinks about this. I do NOT believe, however, based on the studies I've read, that the concave side muscles are overworked. From what I can tell the concave side fiber pattern resembles an atrophic phenotype. More likely that the relative shortening of the concave muscles causes them to lose strength and function. I wouldn't say that makes them less vulnerable to atrophy. I'd actually say the opposite. A shortened muscle will atrophy very quickly versus a stretched muscle...

I also question how 'overstretched' the convex muscles actually are. Muscles placed in a chronically stretched position will hypertrophy. There are lots of animal models demonstrating this. One rebuttal against that would be the time frame. The stretching experiments are done for a week or two. I'm not sure what would happen if the stretching was maintained for months or years. Certainly a critical mass would be reached. No doubt that the convex muscles are more active, via EMG, than the concave though. It's just how to interpret that information that is difficult. The increase in type I fibers on the convex side tells that they are functioning more than the concave side.

From other reading, the right side muscles are underdeveloped. TR can assist here as one exercise or activity specifically targeting that weakness (as you said). Also, the TL fascia, distorted by compensating pelvis and opposite thorax rotation, can't function as intended (used to apply and focus strength). Despite the observation that TR doesn't work as effectively on HT curves, I believe it can indirectly affect those HT curves by strengthening the lumbar; IMO, a compensatory lower curve is itself a contributory mechanism in the progression of structural curves--vicious cycle.

I can recall discussing the compensatory curve issue with the doctor I worked with. In relationship to general AIS management and specifically as it related to bracing. I can remember him saying that if the compensatory curve was held too rigid, particularly in the lumbar region, that a HT curve could develop. It was something he seem to regularly check in most of his TLSO patients. The body will strive for balance. But I would potentially agree with you that the compensatory curves can play some role in the progression of the structural curves.

[TAMZTOM]

Would you think of me less if I said that I'm not sure what our/my point was with that sentence.

Possibly something like, 'Upper right convexity would stretch the entire right side'? I recall having to think about the Schroth explanation when I first read it--wasn't intuitive. Seems as if it would be intuitive after thinking about it, but that's not intuitive, then. :-)

I do NOT believe, however, based on the studies I've read, that the concave side muscles are overworked....

That's what I said! :-)

I also question how 'overstretched' the convex muscles actually are. Muscles placed in a chronically stretched position will hypertrophy.

This is what we've seen with Tamzin: trapezius and rhomboid were hypertrophied back in June - Sept...we've established symmetry by working the other side. (I'll send you a comparative photo by email.)

I'm not sure what would happen if the stretching was maintained for months or years.

Pain? We were first alerted to her scoliosis by complaints of pain from the hypertrophied muscles. With symmetry, now, pain is gone. If I recall correctly, Schroth promotes relieving the overworked and overstretched upper right muscles by focusing on pelvic correction firstly, then the erector spinae and deeper muscles on the concavity below the thoracic convexity (psoas too). With thoracic derotation and pelvic derotation, the TL fascia is better aligned and the illiac spine better able to perform it's supportive function for the torso weight. Thereafter--or simultaneously--stretching the thoracic concavity and working the underused upper left muscles re-establishes supportive function on the entire torso while relieving the strain on the overworked convex side muscles.

I can remember him saying that if the compensatory curve was held too rigid, particularly in the lumbar region, that a HT curve could develop. ... The body will strive for balance. But I would potentially agree with you that the compensatory curves can play some role in the progression of the structural curves.

It does sound sound (!) for the rotating function of the lumbar/pelvis to translate to the HT or cervical segments in overly rigid braces. Good to hear someone with your knowledge and experience consider the role comp. curves could play in structural progression.

Thanks for emailing the pilot study. Comparative photo of Tamzin coming over...now...

[Kevin_Mc]

rooty-tooty-fresh-and-fruity

lol!

I also laugh at this because I add a very proper English accent to that in my head.

Possibly something like, 'Upper right convexity would stretch the entire right side'? I recall having to think about the Schroth explanation when I first read it--wasn't intuitive. Seems as if it would be intuitive after thinking about it, but that's not intuitive, then. :-)

Yeah, I was thinking something like that as well. I had referenced an article that suggested the convex muscles were longer but then there is the shorter multifidus. Perhaps that was it.

This is what we've seen with Tamzin: trapezius and rhomboid were hypertrophied back in June - Sept...we've established symmetry by working the other side. (I'll send you a comparative photo by email.)

I'll comment on the photo further down. The appearance of hypertrophy might just be due to the rotation, i.e. the muscles become more prominent. Or at least the paraspinal muscles. That you see this with the Traps and Rhomboids.. Hmm.. I'd have to think about that one further. It might very well be as you say though.

Pain? We were first alerted to her scoliosis by complaints of pain from the hypertrophied muscles. With symmetry, now, pain is gone. If I recall correctly, Schroth promotes relieving the overworked and overstretched upper right muscles by focusing on pelvic correction firstly, then the erector spinae and deeper muscles on the concavity below the thoracic convexity (psoas too). With thoracic derotation and pelvic derotation, the TL fascia is better aligned and the illiac spine better able to perform it's supportive function for the torso weight. Thereafter--or simultaneously--stretching the thoracic concavity and working the underused upper left muscles re-establishes supportive function on the entire torso while relieving the strain on the overworked convex side muscles.

Yes, perhaps pain. But I'm thinking more along the lines of what actually happens to the muscle itself. Does it hypertrophy a certain amount and then atrophy or does the phenotype change, i.e. initially develop type II fibers but then slowly develop more type I fibers due to the chronic stretch...

Regardless, I understand what you/Schroth are describing here. New things stick out from time to time. And I always love how logical schroth (and to a similar extent side-shift) are in their explanation. Regardless of what is actually happening to the muscles, e.g. stretched, overworked, atrophied, etc..., the goal is ultimately to improve the biomechanics and get everything functioning appropriately.

Thanks for emailing the pilot study. Comparative photo of Tamzin coming over...now...

The pictures are pretty impressive. You've achieved nice balance and clear muscle definition/strength improvement. Very muscular for 10 years old. Considering the number of issues you're working against, it's pretty impressive. Do you have those wooden bars in your house or is that at therapy?

[Kevin_Mc]

Ach, ye dinnae ken whit yer talkin aboot...ah'm Scottish!

DOH!! Nonetheless, that makes it even funnier in my head. I think of Groundskeeper Willie from The Simpsons.

http://www.youtube.com/watch?v=Z9_jI...eature=related

She's looking even better now, 4 months after the last picture I sent. She loves her 6 pack the most, but, since starting ballet, her legs are really shaping up again. Really low body fat despite being on 2400 calories or so, perfectly balanced; only 55 lbs, 133 cm approx...she lost a lot of weight when all 3 conditions hit hard between Jan - June 2011. I'm trying to get some input from our paediatrician and two consultant dieticians, but, frankly, they haven't a clue about, for example, how she can pack on muscle but no fat at all; one hand't even heard of melatonin signalling dysfunction, lysin (sic), mysin or myosin (sic). It is rather backward over here.

Sounds like you have it under control. From a muscle and nutrition point of view, lots of good quality protein is the best advice to give. "Good" proteins are those high in the three branched-chain amino acids (BCAAs), leucine, isoleucine and valine. Dairy, meat, soy. Give protein with some carbohydrate within 2 hours of any workout. Can also give it before or during depending on how strenuous, i.e. if you'll throw it up during the activity then what's the point. A perfect 'low cost' post workout drink is actually chocolate milk. It has a tone of leucine in it and the carbohydrate/sugar stimulates insulin release. So the exercise gets the muscles processing and then you feed that muscle lots of good fuel and give it lots of 'bricks' to build a strong house. Muscle after both strength or endurance exercises benefit greatly from the BCAAs, especially leucine. (I currently study the molecular mechanisms involved in protein synthesis and breakdown after exercise, nutrition and in relation to disease or muscle wasting).

I'm trying to figure out how to 'marry' scoliosis/back issues with my current research.

[TAMZTOM]

I think of Groundskeeper Willie from The Simpsons.

Think Shrek, "Donkey...here...now." About 5 years ago, my English born and accented kids heard me say this literally and almost died. I'd never seen Shrek beforehand.[/QUOTE]

"Good" proteins are those high in the three branched-chain amino acids (BCAAs), leucine, isoleucine and valine. Dairy, meat, soy.

Three more words added to my vocabulary, thanks. She eats steak, salmon, chicken, soya--rotating. Over 100 grams of protein daily. Wife does the mineral, vitamin, carbs, fat, etc., etc., counting. Dairy increase has made a difference. I've said it before, but she really is atypical in her ability to build muscle.

Give protein with some carbohydrate within 2 hours of any workout.

Three years ago, when I started training the girls for track, I digested "Better training for distance runners" by Martin and Coe. I've stuck to Martin's maxim about the 30 minute window after exercise to pack in carbs to replace the glycogen stores.

...the exercise gets the muscles processing and then you feed that muscle lots of good fuel and give it lots of 'bricks' to build a strong house. Muscle after both strength or endurance exercises benefit greatly from the BCAAs, especially leucine. (I currently study the molecular mechanisms involved in protein synthesis and breakdown after exercise, nutrition and in relation to disease or muscle wasting).

You could do another study on Tamzin's metabolism. I can target a muscle group, feed her and the muscle grows. When she's fatigued, I can give her carbs (fruit) and she resembles a grasshopper on steroids after 15 minutes. Fat, however, will not happen--and we need some more! Getting the girl's weight up is a full-time task. (Physically, the closest I can think of is a young Kelly Holmes.)

I'm trying to figure out how to 'marry' scoliosis/back issues with my current research.

From reading, I've mentally lodged numerous references to the large percentage of scoliotic girls with very low BMI's. I've seen many scoliotic kids with the same physique. I've read something about AIS kids having issues with the satiety glands/chemicals/processes...as you can discern, my limited knowledge has many semantic gaps...more like caverns...or the dark depths of Loch Ness.

[TAMZTOM]

Give protein with some carbohydrate within 2 hours of any workout.

I read your post again, something was bugging me. Found it! You're talking "PROTEIN" within the 2 hour window, I was thinking carbs within the 30 minute window. Go it, thanks.

A perfect 'low cost' post workout drink is actually chocolate milk. It has a tone of leucine in it and the carbohydrate/sugar stimulates insulin release. So the exercise gets the muscles processing and then you feed that muscle lots of good fuel and give it lots of 'bricks' to build a strong house. Muscle after both strength or endurance exercises benefit greatly from the BCAAs, especially leucine. (I currently study the molecular mechanisms involved in protein synthesis and breakdown after exercise, nutrition and in relation to disease or muscle wasting).

Tamzin drinks around a litre a day of full-fat milk. Milk over here is pasteurised--vaguely recall that it isn't over in the USA. It's only since June 2011 diagnosis time that we've managed to get her on a healthy diet. Is the chocolate in the milk just cos American kids don't drink straight milk, or is that specifically for the carbs and sugar. If the latter, is fruit better? E.g., apple/plum/kiwi and milk?

I'm trying to figure out how to 'marry' scoliosis/back issues with my current research.

Tamzin's seeming ability to synthesis protein (i.e., her muscle growth), but inability to gain fat (and therefore weight) causes us considerable concern. For an athlete, her low body fat, high muscle percentage is ideal, but she's 10 yrs and needs that fat! I can't remember where I read it, but definitely did read some articles exploring this fat synthesising inability. Any ideas?

[rohrer01]

I know you weren't addressing me. I have a way of butting in now and then. But since I'm online, I thought I would address a couple of questions you have.

Tamzin drinks around a litre a day of full-fat milk. Milk over here is pasteurised--vaguely recall that it isn't over in the USA. It's only since June 2011 diagnosis time that we've managed to get her on a healthy diet. Is the chocolate in the milk just cos American kids don't drink straight milk, or is that specifically for the carbs and sugar. If the latter, is fruit better? E.g., apple/plum/kiwi and milk?

Milk has been pasteurized in the US for a very long time.

Tamzin's seeming ability to synthesis protein (i.e., her muscle growth), but inability to gain fat (and therefore weight) causes us considerable concern. For an athlete, her low body fat, high muscle percentage is ideal, but she's 10 yrs and needs that fat! I can't remember where I read it, but definitely did read some articles exploring this fat synthesising inability. Any ideas?

Muscle weighs more than fat. So I don't understand your concern about her weight gain. Granted she NEEDS fat to mature properly as a female (fat stores estrogen...girls lacking enough fat do not menstuate). But I think this has little to do with actual weight gain. I would think that this would be a general health concern. Is there anyone you can talk to about metabolism? It could be that she is still immature enough that her body hasn't the "need" to store fat, yet. Middle aged kids almost always seem rather lanky and gawky if they are in any kind of shape at all. The girls don't start filling out until later, as puberty begins to progress. She may be a late bloomer.

[AMom]

Muscle weighs more than fat. So I don't understand your concern about her weight gain. Granted she NEEDS fat to mature properly as a female (fat stores estrogen...girls lacking enough fat do not menstuate). But I think this has little to do with actual weight gain. I would think that this would be a general health concern. Is there anyone you can talk to about metabolism? It could be that she is still immature enough that her body hasn't the "need" to store fat, yet. Middle aged kids almost always seem rather lanky and gawky if they are in any kind of shape at all. The girls don't start filling out until later, as puberty begins to progress. She may be a late bloomer.

Hi rohrere01,

If everything else were equal, then your explanation would be correct and reassuring. However, in this case it seems her system isn’t processing incoming calories quite right. I think the problem isn’t that she is lanky; rather their daughter lost too much weight, too quickly. From what I’ve read, she has been able to regain some muscle, but doesn’t have the normal body fat/ reserves a child needs to maintain good health. Adding to that, she is an active young child within an active family, so they need to be careful she doesn’t expend more calories on exercise than she can afford to lose. That balancing act can be pretty tricky stuff.

I am pretty sure folks on this thread want answers from anyone who has them, so I'm glad you responded!

Tom: Due to the high rate of obesity, chocolate milk is treated as a problem in the USA, many school districts are trying to eliminate flavored milk from their campuses.

A Mom

[TAMZTOM]

...she has been able to regain some muscle, but doesn’t have the normal body fat/ reserves a child needs to maintain good health.

Amon, thanks for answering Rohrer. I've taken YOUR thread off-topic. I'll steer these to our general thread.

[Kevin_Mc]

I read your post again, something was bugging me. Found it! You're talking "PROTEIN" within the 2 hour window, I was thinking carbs within the 30 minute window. Go it, thanks.

Yep. Protein WITH the carbs. Especially leucine. Briefly, leucine alone stimulates protein synthesis. Insulin via carbohydrate ingestion, stimulates protein synthesis. Exercise stimulates protein synthesis. Combine any of the above and they are additive. Whey protein is a great supplement. Otherwise milk is just fine.

Tamzin drinks around a litre a day of full-fat milk. Milk over here is pasteurised--vaguely recall that it isn't over in the USA. It's only since June 2011 diagnosis time that we've managed to get her on a healthy diet. Is the chocolate in the milk just cos American kids don't drink straight milk, or is that specifically for the carbs and sugar. If the latter, is fruit better? E.g., apple/plum/kiwi and milk?

The addition of chocolate is a little bit of gimmick and little bit of function. Straight milk has plenty of sugar for insulin stimulation. Post workout a 2:1 or 3:1 (carbrotein) ratio is ideal.

Tamzin's seeming ability to synthesis protein (i.e., her muscle growth), but inability to gain fat (and therefore weight) causes us considerable concern. For an athlete, her low body fat, high muscle percentage is ideal, but she's 10 yrs and needs that fat! I can't remember where I read it, but definitely did read some articles exploring this fat synthesising inability. Any ideas?

As has been said, extremely active kids won't put on fat and in females this can cause menstruation problems. I've never looked at this directly though, i.e. fat metabolism and/or storage issues.

normal body fat/ reserves a child needs to maintain good health.

Tom: Due to the high rate of obesity, chocolate milk is treated as a problem in the USA, many school districts are trying to eliminate flavored milk from their campuses.

A Mom

All good stuff.

Amon, thanks for answering Rohrer. I've taken YOUR thread off-topic. I'll steer these to our general thread.

Is there a general thread on this stuff that you have started?

[TAMZTOM]

Yep. Protein WITH the carbs. Especially leucine. Briefly, leucine alone stimulates protein synthesis. Insulin via carbohydrate ingestion, stimulates protein synthesis. Exercise stimulates protein synthesis. Combine any of the above and they are additive. Whey protein is a great supplement. Otherwise milk is just fine.

Thanks for that, Mr McI. I've moved the discussion so as not to crowd out the torso rotation focus in here. See here:
http://www.scoliosis.org/forum/showt...345#post136345